The Sweet and Lowdown on Sugar Substitutes

We’ve all heard about potentially negative health effects from the sugar that’s added to many of our favorite foods. So these days, lots of us are trying to cut down on our consumption of sugar — not only to lose weight, but also to help prevent maladies like diabetes and heart disease. We can’t help noticing those pastel-colored packets — pink, yellow and blue — on the rack of our favorite coffee shop. But now we’re wondering: Are those sugar substitutes a good alternative to natural sugar? And which one should we choose?

Artificial sweeteners have been around for decades. Six different types (including the ones in the colorful packets) are currently approved as safe by the Food and Drug Administration; a couple of older ones (notably cyclamates) have been banned for many years. In addition to those zero-calorie sugar substitutes, low-calorie sweeteners called sugar alcohols (for example, mannitol and xylitol) are often used as food ingredients. So what’s the difference between them — and which one is best?

That’s not so easy to answer. If you have a rare genetic condition called phenylketonuria, you should avoid aspartame (the blue packet), because your body can’t process the substance. Otherwise, the choice may come down to a matter of taste. Even though they are FDA-approved, some controversy (both fact-based and far-fetched) remains about the long-term safety of sugar substitutes, and their usefulness in preventing obesity and other diseases.

Yet it’s clear that for some people, the consequences of consuming too much sugar could be much worse. So if you’re at risk for diabetes or certain other diseases, sugar substitutes can be an important tool in maintaining a healthier diet. They also have another health benefit: sugar substitutes don’t cause cavities. Further, some sugar alcohols (xylitol in particular) have the property of stimulating saliva flow, and have been shown to actually impede the formation of cavities. Oral health is an important (if sometimes overlooked) component of your general well-being, and several studies have pointed to a link between oral and systemic diseases — for example, diabetes and heart disease.

As with so many aspects of our health, there seems to be no “magic bullet” to cure all our diet-related problems. But used in moderation, artificial sweeteners can be a valuable part of the effort to improve our overall health and well-being. For more information on this topic, see the Dear Doctor article “Artificial Sweeteners.”